Anatomy of the Liver

By
Dr. A.U. Agu

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 Introduction
• An accessory organ of
digestion
• Largest visceral organ in the
body

• Location.
• Right hypochondrium
• Epigastrium
• Left hypochondrium as
far as the left lateral line

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• Growth and size
• Infancy to adulthood
• Rapidly increases in size.
• Plateau around 18 years
• Decrease in weight from middle age

• Infancy= 5% of the body weight

• Adulthood = 2%
• also varies with
• Sex,
• Age and
• Body size
• Adult =1.5kg

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• Shape
– wedge shape
– determined by the form of
the upper abdominal cavity

• Color
– Reddish brown(through out
life)
– Yellowish(steatosis)
• Texture
– Smooth, soft to firm
– friable

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• Surfaces
– Superior,
– Anterior,
– Right,
– Posterior
– inferior surfaces,

• Diaphragmatic and visceral

surfaces—more appropriate

• Border
– Has a distinct inferior border

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• At the infrasternal angle
– accessible to examination by
percussion
– not usually palpable.

• In the midline
– Near the transpyloric plane
about a hand's breadth below
the xiphisternal joint.

• In women and children

– projects a little below the right
costal margin.

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 Superior surface
• The superior surface is the largest
surface

• Lies immediately below the

diaphragm

• The majority of the superior surface

lies beneath the right dome

• There is a shallow cardiac impression

centrally
• The left side of the superior surface
lies beneath part of the left dome of
the diaphragm
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 Anterior surface
• Approximately triangular and
convex

• Covered by peritoneum except

at the attachment of the
falciform ligament.

• On the right the diaphragm

separates it from the pleura and
6th to 10th ribs and cartilages

• On the left from the 7th and 8th

costal cartilages.
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Right surface
• Covered by peritoneum
• Adjacent to the right dome of the
diaphragm
• This separates it from the right lung and
pleura and 7-11th ribs

• Upper 3rd
• Right lung and basal pleura
• Middle 3rd
• Diaphragm, costodiaphragmatic recess
lined by pleura, 9th 10th ribs

• Lower 3rd
• Diaphragm
• Thoracic wall

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 Posterior surface
• Convex
• ‘bed' of the liver
– A deep median concavity
– Triangular bare area
– The inferior vena cava
– fissure for the ligamentum
venosum
– fundus of the stomach

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Inferior surface
• Bounded by the inferior
edge of the liver

• Marked near the

midline by a sharp
fissure which contains
the ligamentum teres

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 Recesses around the liver
• Subphrenic recess

• Subhepatic space

• Hepatorenal recess

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 FUNCTIONAL ANATOMICAL DIVISIONS

• Couinaud's division
• Into eight (subsequently nine) functional segments
• Based on
• Distribution of portal venous branches
• The location of the hepatic veins in the parenchyma

• Hjortsjo ,Healey & Schroy

• Using the biliary system as the main guide for
division of the liver

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 The fissures and sectors of the liver
• Four portal sectors by the four
main branches of the portal
vein.
• right lateral
• right medial
• left medial
• left lateral
• The three main hepatic veins
lie between these sectors as
intersectorial veins.
• The fissures containing portal
pedicles --hepatic fissures.
• Each sector is sub-divided into
segments (usually two) 14
Subdivision cont.

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Lobes of the Liver
• Divided into
• right Gall bladder
• left
• Lig teres
caudate
RT Q
• quadrate lobes
• by the surface peritoneal
and ligamentous LT
attachments.
C

Lig venosus

IVC

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17
 Supports of the liver
• Static and dynamic factors
• Richelme & Bourgeon (1973)
• Primary factors
• The inferior vena cava
• Hepatic veins
• Coronary and triangular ligaments
• Seccondary factors
• Right kidney
• Right colonic angle
• Duodenopancreatic complex
• Tertiary factors
• The falciform ligament

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 Other factors
• Positive intra-abdominal pressure

• The movement of the diaphragm during

respiration.

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Peritoneal attachments and ligaments of the
liver
• Falciform ligament
• Coronary ligament
• Triangular ligaments
• Lesser omentum
• Ligamentum venosum

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21
 Porta hepatis
• Deep fissure on the inferior
surface of the liver
• Between the quadrate lobe
in front and the caudate
process behind
• Contains the
• Portal vein
• Hepatic artery and
• Hepatic nervous
• The right and left bile ducts
• Some lymph vessels

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 Vascular supply of the liver
• The portal vein

• Hepatic artery

• Hepatic veins

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 Hepatic artery
• Coeliac trunk

– Splenic

– Hepatic(common)
• Right gastric
• Gastroduodenal
• Proper hepatic
– Right hepatic
– Left hepatic

– Left gastric

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 Portal vein
• Begins at the level of the 2nd
lumbar vertebra

• Formed from the convergence

of the superior mesenteric and
splenic veins

• It is approximately 8 cm long

• Lies anterior to the IVC and

posterior to the neck of the
pancreas.
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Areas of porto-systemic anastomosis

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 Hepatic veins
• Three major hepatic veins
• Right
• This is the longest
• Largest vein
• Most variable
• Middle
• Left
• Minor veins
• Vary in number from one to five
• Accessory right ,middle or
inferior hepatic vein(rare)
• The three major veins are
located between the four major
sectors of the liver
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 Lymphatics of the liver
• Divided into

– Superficial

– Deep systems

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 Superficial
Hepatic lymphatics
• Subserosal areolar tissues
• Drain in 4 directions;
• Pericaval nodes
• Majority of the posterior
surface,
• Caudate lobe
• Posterior part of the inferior
surface of the right lobe
• The thoracic duct
• Vessels in the coronary
• Right triangular ligaments

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• Para-cardiac nodes
• Posterior surface
• Lateral end of the left lobe
• Hepatic nodes(porta hepatis)
• Inferior surface,
• Anterior surface
• Most of the superior surface
• Coeliac nodes.
 Rt surface & rt end of superior surface
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 Deep hepatic vessels
• Within the substance of
the liver.
• Ascending trunks
• Accompany the hepatic
veins into nodes around
the end of the inferior
vena cava.
• Lower portion
• Form descending trunks
• Emerge from the porta
hepatis

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 Innervation
• Derived from the hepatic plexus
• Largest derivative of the celiac plexus.
• This plexus consists of
• Sympathetic fibers from the celiac plexus
• Parasympathetic fibers 4rm ant & pst Vagal trunk
• Supply the parenchyma
The capsule is supplied by some fine branches of the lower
intercostal nerves,
• also supply the parietal peritoneum, particularly in the ‘bare area'
and superior surface:
• distension or disruption of the liver capsule causes quite well
localized sharp pain.

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 Clinical anatomy
• Palpation of liver
• Rupture of liver
• Portal–systemic anastomoses
• Hepatic lobectomies and segmentectomy
• Subphrenic abscesses
• Referred pain

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• THANKS FOR LISTENING

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